Abstract
BackgroundCaudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD.MethodsA retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects.ResultsA total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000).ConclusionGeneral anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.
Highlights
Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population
According to the methods of anesthesia, they were divided into two groups: general anesthesia group (GA group) and general anesthesia combined with caudal block group (GA + Caudal blocks (CA) group)
A total of 47 children who were diagnosed with Hirschsprung disease (HD) by pathological biopsy and underwent laparoscopicassisted Soave pull-through procedures were enrolled in this study, including 20 in the GA group and 27 in the GA + CA group
Summary
Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. Few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. Hirschsprung disease(HD) is a common congenital malformation of the digestive tract in infants which characterized by the absence of enteric neurons in the distal colon. Surgery is the primary treatment for HD, and we perform an averaged 25 operations in our hospital per year. The anal canal is narrow and the internal sphincter is very weak in infants, making the pull-through procedure difficult. Excessive anal canal traction during operation can damage the internal sphincter and cause adverse effects [3]. Adequate analgesia and anal muscle relaxation induced by anesthesia are very important during the operation
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